Study: End-of-Life Care Remains Aggressive for Patients With Ovarian Cancer

A recent study has found that patients with ovarian cancer frequently receive aggressive end-of-life care despite industry guidelines that emphasize quality of life for those with advanced disease.

As of 2016, ICU stays and emergency department (ED) visits in the last month of life had become more common for patients with ovarian cancer than they were in 2007, the earliest year from which researchers analyzed data, according to the study, published by researchers at the University of Michigan.

In addition, the proportion of non-Hispanic Black people who turned to the ED for care was even higher, double that of non-Hispanic whites. Black people were also approximately twice as likely to undergo intensive treatment, including life-extending measures, such as resuscitation or the insertion of a feeding tube.

“Although the early integration of palliative care and the reduction of intensive and invasive end-of-life care have been included more and more in guidelines, these recommendations are not making enough of a difference in the type of care people with ovarian cancer receive at the end of their lives, especially for people of color,” said Megan Mullins, PhD, MPH, first author of the study, in the press release.

The American Society of Clinical Oncology and the National Academy of Medicine recommend palliative care, which focuses on relieving symptoms and elevating quality of life, for those with a prognosis of less than 6 months to live, according to the study.

The researchers used the National Cancer Institute’s cancer registries, known as Surveillance, Epidemiology, and End Results (SEER), to examine the medical histories of close to 8000 people who died between 2007 and 2016, all over 66 years of age and on Medicare. Ovarian cancer was their only cancer diagnosis.

The team found that some end-of-life measures are trending in a positive direction, including hospice enrollment going up over time and the proportion of people with ovarian cancer who undergo invasive procedures decreasing. However, the number of months they spend in hospice, as well as the proportion receiving chemotherapy in their last 2 weeks of life did not change significantly from 2007 to 2016, according to the study.

The overall increase in ED visits and ICU stays, plus the notable disparities in certain end-of-life measures for Black people, are disappointing, according to Mullins.

“Prognostication is difficult,” Mullins said in the press release. “But being honest about the risks and benefits of treatment is important. Engaging in conversations with patients about the goals of their care allows them to consider how they would like to spend the time they have left.”

Further research is needed to explore why aggressive end-of-life care persists for people with ovarian cancer, according to the study. Explanations could include emotional toll of end-of-life conversations on physicians, lack of patient understanding about the impact of continuing certain cancer treatments on their quality of life, presence of additional chronic conditions that could worsen symptoms enough to require hospitalization, and patients’ cultural preferences or providers’ perceptions of them.

“It’s very important that we actually understand why these preferences exist and how we can address them,” Mullins said in the press release.

REFERENCE

End-of-life care remains aggressive for people with ovarian cancer. Michigan Health Lab. Published April 5, 2021. Accessed April 6, 2021. https://labblog.uofmhealth.org/industry-dx/end-of-life-care-remains-aggressive-for-people-ovarian-cancer